Individual patient education for people with type 2 diabetes mellitus
- 21 January 2009
- journal article
- review article
- Published by Wiley in Cochrane Database of Systematic Reviews
- Vol. 2009 (1), CD005268
- https://doi.org/10.1002/14651858.cd005268.pub2
Abstract
Background Type 2 diabetes is a common and costly chronic disease which is associated with significant premature mortality and morbidity. Although patient education is an integral component of diabetes care, there remain uncertainties regarding the effectiveness of different methods and modes of education. Objectives To evaluate the effectiveness of individual patient education on metabolic control, diabetes knowledge and psychosocial outcomes. Search strategy Multiple electronic bibliographic databases were searched, including The Cochrane Library, MEDLINE, Premedline, ERIC, Biosis, AMED, Psychinfo, EMBASE, CINAHL, APAIS-health, Australian Medical Index, Web of Science, dissertation abstracts and Biomed Central. Selection criteria Randomized controlled and controlled clinical trials which evaluated individual education for adults with type 2 diabetes. The intervention was individual face-to-face patient education while control individuals received usual care, routine treatment or group education. Only studies that assessed outcome measures at least six months from baseline were included. Data collection and analysis Information was extracted by two reviewers who summarized both study characteristics and outcome statistics. A meta-analysis using a fixed-effect model was performed if there were adequate studies with a specified outcome of sufficient homogeneity. For outcomes where there were too few studies or the assessment measurements were not standardized or variable, the results were summarised qualitatively. Main results Nine studies involving 1359 participants met the inclusion criteria. Six studies compared individual education to usual care and three compared individual education to group education (361 participants). There were no long-term studies and overall the quality of the studies was not high. In the six studies comparing individual face-to-face education to usual care, individual education did not significantly improve glycaemic control (weighted mean difference (WMD) in HbA1c-0.1% (95% confidence interval (CI)-0.3 to 0.1, P = 0.33) over a 12 to 18 month period. However, there did appear to be a significant benefit of individual education on glycaemic control in a subgroup analysis of three studies involving participants with a higher mean baseline HbA1c greater than 8% (WMD 0.3% (95% CI-0.5 to-0.1, P = 0.007). In the two studies comparing individual to group education, there was no significant difference in glycaemic control between individual or group education at 12 to 18 months with a WMD in HbA1c of 0.03% (95% CI-0.02 to 0.1, P = 0.22). There was no significant difference in the impact of individual versus usual care or group education on body mass index systolic or diastolic blood pressure. There were too few studies to perform a meta-analysis on the effect of individual education on dietary self management, diabetes knowledge, psychosocial outcomes and smoking habits. No data were available on the other main outcome measures of diabetes complications or health service utilization and cost analysis in these studies. Authors' conclusions This systematic review suggests a benefit of individual education on glycaemic control when compared with usual care in a subgroup of those with a baseline HbA1c greater than 8%. However, overall there did not appear to be a significant difference between individual education and usual care. In the small number of studies comparing group and individual education, there was an equal impact on HbA1c at 12 to 18 months. Additional studies are needed to delineate these findings further.Keywords
This publication has 78 references indexed in Scilit:
- Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trialBMJ, 2008
- Evaluating the Effectiveness of a Participatory Empowerment Group for Chinese Type 2 Diabetes PatientsResearch on Social Work Practice, 2006
- Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitusCochrane Database of Systematic Reviews, 2005
- Group based training for self-management strategies in people with type 2 diabetes mellitusPublished by Wiley ,2005
- Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized studyActa Diabetologica, 2004
- Measuring inconsistency in meta-analysesBMJ, 2003
- “Sticking to it—Diabetes Mellitus”: A Pilot Study of an Innovative Behavior Change Program for Women with Type 2 DiabetesAmerican Journal of Health Education, 2002
- Evaluation of a diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for mild type 2 diabetes and IGTEnvironmental Health and Preventive Medicine, 1999
- The Relative Effectiveness of Educational and Behavioral Instruction Programs for Patients With NIDDM: A Randomized TrialThe Diabetes Educator, 1996
- Randomized Controlled Multicentre Evaluation of an Education Programme for Insulin-treated Diabetic Patients: Effects on Metabolic Control, Quality of Life, and Costs of TherapyDiabetic Medicine, 1991